How To Do Intermittent Fasting For Weight Loss & Better Health

Coming up on this episode of the Doctor's Pharmacy.

Your body has its own innate healing system, which is way, way more powerful than any drug ever invented and can reverse almost every disease if we know how to activate it. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me, helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to understanding what each individual person and body needs is testing, which is why I'm excited to tell you about Rupa Health. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables can help us find the most effective path to optimize health and reverse disease. But up till now, that meant you are usually ordering tests for one patient from multiple labs. and I'm sure many of you can relate how time consuming this process was, and then it could all feel like a lot of work to keep track of. Now there's Rupa Health, a place for functional medicine practitioners to access more than 2000 specialty labs from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. Rupa Health helps provide a significantly better patient experience and it's 90% faster, letting you simplify the entire process of getting the functional medicine lab tests you need and giving you more time to focus on patients. This is really a much needed option in functional medicine space and I'm so excited about it. It means better service for you and your patients. You can check it out and look at a free live demo with a Q&A or create an account at RupaHealth.com that's R-U-P-A-Health.com Now one of today's episode sponsors is ButcherBox. I love this company because they make eating high quality meat and seafood accessible, affordable and most importantly really delicious. When I talk about high quality animal protein, that means caring for the lives of the animals and the livelihoods of the farmers, reducing our impact on the environment and the climate, and feeding our bodies real food to promote optimal health. This is a huge caveat when it comes to eating meat and seafood. It has to be clean to be a good part of your diet. Butcher Box delivers 100% grass-fed grass-finished beef and wild-caught salmon right to my door. They have different package and frequency options available so you can order the best combination for you and your family without any penalty if you decide to cancel. And shipping is always free. The meat and seafood I get from ButcherBox is way better than what I find in the grocery store. For a quick weeknight meal this time of year, I love grilling up some of their wild-caught salmon and throwing it together with some arugula, red onion, lots of basil, balsamic vinegar, alongside some spaghetti squash. Yum. When you sign up to ButcherBox today, you'll get two pounds of wild-caught Alaskan salmon, free in your first box, plus $10 off by going to butcherbox.com/ pharmacy. That's two pounds of sustainably caught wild Alaskan salmon free, plus $10 off your first box by going to butcherbox.com/ pharmacy. That's F-A-R-M-A-C-Y. I hope you take advantage of this great offer. I know you're gonna love ButcherBox as much as I do. Now let's get back to this week's episode of the Doctor's Pharmacy. Hey everyone, it's Dr. Mark Hyman and welcome to a new series on the Doctor's Pharmacy called Masterclass, where we dive deep into popular topics about health including inflammation, autoimmune disease, aging, brain health, sleep and much, much more. And today I'm joined by my guest host and my good friend and business partner and host of the Drew-Proweet-Podcast, Drew-Proweet. And we're going to be talking about how to use when you eat and some other eating hacks to improve your metabolic function, brain health, reduce your risk of disease, and even slow down and maybe even reverse aging. So let's get going. Welcome, Drew.

Mark, honored to be here, excited about this topic here. There's so many questions that people have about intermittent fasting, fasting, time-restricted eating, but let's hit people with some immediate value and get them excited. What are three to five top benefits of this whole ecosystem of fasting?

So, we're going to get into all the nitty-gritty of all the ways to access your body's healing system through focusing on when you eat, calorie restriction, ketogenic diets. We're going to go all into that. But at a high level, your body has its own innate healing system, which is way, way more powerful than any drug ever invented and can reverse almost every disease if we know how to activate it. And so all these approaches that are being heavily researched and are incredibly powerful do very similar things. And in a sense it has to do with this basic framework. Our biology is adapted to scarcity, to starvation. When we were hunter-gatherers, we didn't know if we were going to be able to kill a buffalo or find a root or a berry. So we had to be really good at managing lack of food. and when we do that, it activates all these conservation healing repair systems so the body can actually survive without food. Now, the problem today is we are in a state of abundance. In America, we have 500 calories more a day than we did 40 years ago, and we're eating them, which is why we're so obese in America. So there's no problem with scarcity. It's abundance, and we don't have the genes to regulate abundance. We have over 200 genes that regulate starvation and to help us adapt. So what happens when you activate this ancient healing system? Well, first, you radically change your hormones, your cells and your genes. You change your gene expression and optimized expression that controls inflammation, that increases your antioxidant systems, that gets rid of belly fat, that builds muscle, that increases your brain and focus and cognitive function because, you know, when you're starving, you gotta go look for food. You wanna be alert. It helps build your bone density, it increases your beneficial hormones, helps growth hormone, and it also helps repair your cells. It also activates something really extraordinary, which is something called autophagy and mitophagy. What does that mean? It means your body has a system of cleaning up and recycling old parts. And when you don't do that, you end up with a lot of old parts. And so, the goal of autophagy is to literally break down all the components of your cells and then clean them up and then rebuild them into new parts, which is awesome. But if you don't do that, and a lot of the ways we live today in the 21st century do not let us do that, we end up aging rapidly. So not only does it help you lose weight and build muscle, not only does it help balance your hormones, increase your antioxidant systems, increase your stem cell production, increase your brain chemistry focus, but it also can actually reverse aging. And there's a lot of data on how it actually can help in literally reversing the aging process. It also is protective against cardiovascular disease. It may be effective in cancer treatment. And we know that applying these strategies during cancer reduces the side effects, reduces the complications and increases the efficacy and the benefits of traditional cancer chemotherapy. So we're just scratching the surface and there's so many powerful processes that are activated by these strategies. And we're gonna get into those, but that's the high level. So if there's one single thing you can do to activate almost every single healing system in your body, it's changed when you eat.

Now, you had a great newsletter recently, and you were talking about this concept called zombie cells, which directly ties in to what you just gave in the overview about autophagy. I find it as a fascinating example. Can you just talk about what these zombie cells are and how they end up floating around our body?

So it's complicated, but zombie cells are what they sound like. They kind of don't die, and they're, kind of cells that increase senescence or aging that are part of our immune system. So the aging process is one of inflammation or inflammaging we call it. And what happens is because of all life's stresses and toxins and poor diet and all the things we're exposed to, our bone marrow stem cells that make our white blood cells that are part of our immune system get damaged. And those stem cells then produce damaged progeny. which are damaged cells. So we produce a million T cells a minute in our bone marrow and they can get into our circulation. But if they're funky, which they are, they're called chipped cells, then they create downstream effects of more inflammation, more heart disease, more autoimmunity and so forth. And so zombie cells are part of this whole cocktail of dysfunction. And what's exciting is by doing some of these practices and by including certain foods in your diet, for example, Himalayan Tarter Buckwheat, which is an ancient plant, it's not a grain actually, it's a flower, can help to increase the killing of the zombie cells and improve this whole immuno senescence and create something instead called immuno rejuvenation.

And fasting is a part of that whole process as well too.

Absolutely.

Now let's take a step back and talk about some of the recommendations. I remember reading articles in the early 2000s that it's dangerous to fast and people shouldn't fast and there was all these concerns and people were being told instead to eat every couple of hours. That was actually the best way to keep your metabolism high and burn more energy. Why did people think that back then? How is that wrong and what changed it? Well, I think we had a view that in order to balance your blood.

Sugar, you had to eat every 3 to 4 hours. And I often advise patients about that. These are people who are overweight, who had swings. And we did advise people not to eat before bed, like 3 or 4 hours, because it makes you gain weight. I call it the Sumo Wrestler Diet, which is how they gain weight. They eat and they go to sleep.

And they drink a bunch of alcohol too.

And they drink alcohol, they have something called chanko nabe, which is huge like kind of Japanese stew soup, which is yummy, but also it fills you right up and they can't even do that. But I think we kind of got in this idea that you have to eat all the time to keep your metabolism running and going and keep it burning and it just turned out not to be true. In fact, it turned out the opposite is true, that if we learn how to eat, and focus on what we eat. We don't have to worry about gaining weight or overeating because it will balance our blood sugar and insulin levels and will keep our metabolism even. So if you eat the right foods, you don't have to worry about eating that often because you won't be hungry. You'll eat and then you'll be hungry, you know, hours and hours later. You don't have to eat every three or four hours. The second thing we figured out is that the body needs rest from food, which is why we have something called breakfast or breaking the fast, except most people eat up until they go to bed. We have a snacking culture, and then they eat as soon as they wake up, and they don't get that rest period of at least 12 hours or 14 or 16 hours, which really ends up being extraordinarily beneficial for helping to not only repair and clean up waste and do the repair process that happened at night, but to actually activate all the healing systems your body we talked about. to reverse diabetes, reverse heart disease, improve your cognitive function, maybe improving your risk of Alzheimer's or reducing your risk of Alzheimer's. It helps build muscle, it reduces belly fat, it reduces inflammation, it increases your antioxidant systems, it increases stem cell production. So this is what we now know about these things.

And so we kind of got it wrong before. So I think this is a perfect time to go through the spectrum of different things that fall under the umbrella of fasting. Can you walk us through a few Talk to us about what they are and how they're done.

So there are many roads to Rome. There are many ways to access these healing systems in your body. And they're each slightly different, but they all do very similar things. So we have what we call intermittent fasting. I think most people, when they say that mean time restricted eating, meaning they eat within an eight or a 10 or a 12 hour window, meaning you don't eat for 12, 14, or 16 hours a day. That's what we call time restricted eating. And that's been extensively studied and is great for weight loss, for metabolism for helping with a whole host of chronic illnesses. The second is true intermittent fasting, which may be a 24 hour or a 36 hour fast once a week, or it could be a three day fast once a month. There's a lot of ways to do it. Then there's what we call fasting mimicking diets, which are calorie restricted. So you'd eat, like, say 800 calories a day for five days. Dr. Walter Longo, who wrote the Longevity Diet, he's been on the podcast. He's done a lot of research on that and has millions of dollars in NIH funding to look at how it affects cancer, heart disease, diabetes. aging and so many other things. And because your body thinks it's starving, you're not eating enough calories, but your body's still getting some energy so you can function better, but it's really a very powerful system. And then there's the ketogenic diet, which is, sounds like you're still eating, and you can do keto with time-restricted eating or intermittent fasting too, but keto itself is what happens to the body when we stop eating. When you have no food, your body starts to burn, your body stores of fat. Now, what's fascinating is we have about 2,500 calories of carbohydrate stored in our tissues as glycogen in our muscle. So when you do the carb loading for a workout, that's what they're trying to do, trying to fill up your glycogen stores. The problem is if you're doing a long marathon run, I mean, I went for a 50 mile bike ride and I saw my calorie burn and I was like 2,300 calories towards the end of it and I'd sort of run out of gas from my glycogen. But the body has about 30 to 40,000, maybe more depending on your weight, can have a lot more calories of fat. So wouldn't it be better if you could burn the fat? So your body is like a hybrid car, right? Electric and gas. The gas is carbohydrates and it burns dirty. The keto, which is fat burns clean. So your cells can burn fat or carbs. And when you burn fat, again, it's often that we had to do that because we were in a state of starvation, it activates all the same healing mechanisms. So ketogenic diets can have been shown to reverse cancer, have been shown to be helpful in Alzheimer's, reverse type 2 diabetes, the work of Virta Health and our colleagues and friends there, Sarah Hallberg and Sami, have shown that we can reverse type 2 diabetes even in advanced cases using a ketogenic diet. because it activates all these healing repair mechanisms. There's no drug on the planet that can reverse diabetes. We manage diabetes. We do chronic disease management by giving them drugs and insulin and we keep their blood sugar ideal and manage all the risk factors, which is nonsense because when you understand how the body works, you can work with it rather than against it and activate these healing systems. So ketogenic diets do the same thing. And then lastly, there's true true calorie restriction for long-term diets. And this is the only thing in animal studies has really shown to extend life by a third. So in a human terms, that means if you ate a third less calories, you'd live a third longer. Instead of living to 80, you'd live to 120. Now, I know people who are on these calorie restriction for life. There's a whole society. I met some of them. I'm like, so what do you eat? I'm like, well, I have five pounds of celery for breakfast, and I have three pounds of tomatoes for lunch. And I'm like, I'm like, that doesn't sound like fun. I'm going to skip that. And so what's been happening is that science has been exploring how to activate the same mechanisms that control aging without having to starve yourself your whole life, because that doesn't seem like fun. So there's little hacks and tricks that you can use like time-restricted eating, intermittent fasting, fasting mimicking diets, ketogenic diets, all can be ways to access that same.

Healing system in the body. So the question that a lot of people have is how do they decide where to get started and when to explore these different options on the spectrum of fasting?

It depends on you. Okay. Everybody should do a 12-hour fast a day. There's nobody who shouldn't do that.

And walk us through that. Just so that makes super sense.

You eat dinner at six, you can eat breakfast at six, you eat dinner at eight, you can eat breakfast a day. It's pretty simple.

It's simple but actually a lot of.

People don't do it. No, they don't do that. They eat late and they snack at night and they have ice cream, whatever snacks before they go to bed. Bad idea. Give yourself at least 12 hours and that's good for everybody. When you start to move to 14, I mean think about it. If you eat dinner at 6:00, you can eat breakfast at 8:00, that's a 14-hour fast or if you want to do 16, you can eat dinner at 6:00 and have something at 10:00. So, it's doable for a lot of people and I do it very often. You don't have to do it every day. I do it many days a week. Some people who are overly thin, certain people with disorders like cancer, you have to be careful because there's weight loss issues that can happen. It can be stressful for the body for some people. So it's not for everybody. If you have adrenal issues, if you're very tall, thin women may not be effective for, might cause symptoms. So it's not, everybody should do a long 16-hour fast. In terms of the true intermittent fasting, that can be a very therapeutic thing. So you can do a day, a two-day, three-day, five-day, seven-day, 10-day, some people do three-week, just water fast. That can be very therapeutic if you have some type of severe chronic illness and it can reset the system. Then there's the ketogenic diets, which are really effective for certain conditions like type two diabetes. Alzheimer's, autism, Parkinson's, those can be very effective. It's a little harder to do. I don't know if people should be on it all the time. So there's a lot of nuances to prescribe it as a medical therapy. But it also can be very effective. So I would sort of for people start, I would say start with the 12 hour fast. If you want to move to 14, 16 is not that hard for most people. So try it on, see how you feel, see what happens. Often people have more energy, more focus, they lose weight, they increase body, muscle, decrease belly fat, and have lots more energy. So there's no magic to it, it's just looking at who you are, what your issues are, how do you match the right approach to you, and then try them and see how you feel. Because if you, for example, if you do a 16-hour fast and you feel like crap, maybe it's not right for you.

But there could be some underlining reasons, which is why it's important to get educated on it. Your blood sugar might be out of control, and there's a few of your friends and Colleagues, Peter Tiah has a free fasting app that's out there. Dr. Jason Fung has one as well. They've both been on your podcast before. Jason Fung has been on my podcast before. We'll link to those show notes that are out there. And this is the start of getting people excited about wanting to go down the path of education to learn what it is. Now, in your instance, you mentioned that with time-restricted eating, you'll often do that. You'll often do that a few days a week. When it comes to these other fasts that are there on the spectrum, do you incorporate those in your own life?

Yeah, I mean, I've tried everything. I've tried calorie restriction diets. I've tried, you know, 24, 36 hour fast. I once did a sort of four day juice fast, which is just green juices. I also have tried keto. If I do keto too much, I just drop too much weight. I just, like, I. It's. It's a problem for me. I probably shouldn't say that. I get shot down, but I. I do need some carbohydrate, and. And it really depends on your metabolism, so. I don't have any diabetes, I'm very lean, I don't have any insulin issues. And so for me, it may help me with certain other issues, but I often will really customize the way I prescribe diets based on what's going on with that person. So if someone's overweight, if they're diabetic or on the spectrum of diabetes, I will recommend a ketogenic diet. If someone has Alzheimer's or autism, I recommend it. I don't think it's for everybody. During cancer therapy, which is amazing, it can be extremely effective in magnifying the benefits of traditional radiation and chemo and minimizing the side effects. So there's a lot of therapeutic benefits around it in terms of cancer, in terms of Alzheimer's, even in heart disease. What was interesting with the group that was run by Sarah Hallberg, who's part of Virta Health, is they looked at not only the weight loss, it was a 60% reversal of type 2 diabetes, 100% the patients got off the main medication for diabetes called oral hypoglycemics. 90 plus percent got off insulin to reduce their dose. Weight loss was 12%, which is staggering. Most weight loss studies, we get 5%, people are jumping up and down. They also looked at, I think, 20 or plus different biomarkers of cardiovascular disease, and almost every single one was improved. So you think I'm eating like 70% fat, I'm eating saturated fat, how does that work? How does that work where all my heart disease risk factors get better because it contradicts everything we knew about eating a high fat diet? Well, it's because if you have a certain metabolic type, namely if you're diabetic or insulin resistant on that spectrum, that's what will happen. But I have other patients, for example, I had one patient I put on a ketogenic diet of coconut butter and butter and basically veggies and a little protein, and she had been struggling with her weight, had been very inflamed, her cholesterol was over 300, her triglycerides were like 300, 400, very low HDL, which is a good cholesterol, and we just couldn't budge her. And so I said, why don't you try this? And she tried it and she immediately lost 20 pounds and her cholesterol dropped over 100 points, her triglycerides dropped like 200, 300 points, her HDL went up and she did amazing. On the other hand, I had a patient who was a mid-50s guy who was an athlete and an aggressive bike rider going for 50, 100 mile bike rides. and he's like, I want to try it and see if it helped my performance. And he tried it and his cholesterol numbers just went off the chart. So we had to stop. So everybody's different and there's a lot of heterogeneity, but you have to experiment yourself. And what I say to people is the smartest doctor in the room is your own body.

You've also had an experience that your cholesterol went in the wrong direction on a super high fat diet. Just another reason... High saturated fat. High saturated fat diet. Another reason that it's important to remember that everybody operates operates a little bit differently. There are broad spectrum themes that are there. Do you want to talk about that a little bit?

Because I think it's useful for some people to know about. I mean, you know, in term, we're sort of veering off a little bit from the sort of fasting thing and talking more about eating a high saturated fat diet. Now, many, many studies have shown that saturated fat seems to contribute to heart disease. But when you look at the data carefully, it's in the context of an American processed diet. in the context of a high carbohydrate starch sugar diet. When you eat saturated fats with starch and sugar, flour and sugar, it's deadly. However, if you eliminate starch and sugar or grammatically reduce it, most people will tolerate saturated fats. However, there's a small group they are called lean mass hyper responders. Meaning they're guys like me who are athletic, who are muscular, who, I mean, I'm not like you know, I'm like a bodybuilder muscular, but I'm mostly muscle and very little fat. They tend to have this phenomena where they have the opposite response in terms of their cholesterol than you'd expect. So their LDL goes up, their particle number goes up, their size goes down. It's kind of a wacky thing. So I think what we're learning is that there's a lot of genetic variability in the population, and we have to actually match the diet to our genes and to our own personal biology. so I always say don't let your ideology trample over your biology. Make sure, you know, oh, ketogenic diet sounds good, I'm gonna do that. Saturated fat is good. No, it may not be for you, you know? It may not, and that's okay. And I think you have to really customize your diet to what works. And then I can eat olive oil, I can eat avocados, I can eat.

Nuts and seeds, I can have a lot of fat in my diet, I just don't have saturated fat. Let's talk about the impact on sleep.

What do we know about sleep?

And fasting, specifically time-restricted eating?

Well, it seems to be that the time-restricted eating helps to improve sleep quality in terms of the amount of sleep, the depth of sleep, and all the sleep cycles. So, it's one of those sort of interesting findings that it actually helps to, which is important because when you sleep and you sleep well, it's when your body's in the repair shop. It's when growth hormone increases, which repairs tissues. It's when cortisol goes down. It's when blood sugar goes down. all these systems kick into gear to help the body reset and repair. So the better and the deeper your sleep, the more you'll heal. And it seems to be part of this idea of this adaptation to scarcity is that when we're in this fasted state, our bodies just prepare better and heal better and sleep better because sleep is part of the healing process.

Can you talk about some of the protection against neurodegenerative disorders like Alzheimer's and Parkinson's disease when it comes to the spectrum of fasting?

Well, it's really interesting findings because we're learning that one of the biggest drivers of Alzheimer's is sugar. And in fact, scientists have called Alzheimer's type 3 diabetes. It's diabetes in the brain. And there's a subset, a big subset of people with Alzheimer's, because they're not all the same. Some might be brier of metals or mold or lime or whatever, but the large subset is insulin resistant, and it's insulin resistance in the brain. And that's really driven off of carbohydrates. So when you have a high carbohydrate diet, starch and sugar, and even, you know, what they think of as good carbohydrates, grains and beans, it can increase insulin and it can actually damage your brain. So it's really important to understand that, that if you have Alzheimer's, this may be going on, and there's ways to test for it. And I've had many patients, you know, with insulin resistance, diabetes, and Alzheimer's, and this works amazing for them. And when you put them on a ketogenic diet, it really helps their brain function better. Why? Because when your body's running on ketones, one, you reduce inflammation, which is the main cause of Alzheimer's, oxidative stress, which is a big factor in Alzheimer's, you increase mitochondrial function, which is your energy centers in the brain, so your brain works better. and you obviously cut out the starch and sugar which cuts out the insulin resistance in the brain and helps all these things work together. So what happens is when you put people on a high fat diet, and by the way, the brain is made up mostly of fat, it's 60% fat, mostly DHA which is for fish oil. So when you actually, and it's got a lot of saturated fat in there and a lot of other things in the brain. So it's not that fat is bad, you need fat for your brain and when you get in a keto diet, when we were in this state before, it was a state designed to increase our brain function. Why? Because if you're starving and you can't find anything to eat, you better be focused, alert on top of it so you can hunt and gather and find something to eat, otherwise you die. So there's an evolutionary reason for us to have better mental focus and concentration and memory and attention when we're in a ketogenic state or in a fasted state. So, I think that's the mechanism of action of how it works.

Now, I want to talk about fasting for women and their unique biology. How is fasting and the spectrum of fasting different for women, especially women in their childbearing years?

Well, this is why, Drew, I really emphasize the importance of personalization because this might be good for some people, it also may not be good for others. So if you're a woman who's in the childbearing years, if you're a woman who's breastfeeding, who's pregnant, who's very thin, who has adrenal issues, and a lot of people do from chronic stress in your lives, having long periods of not eating is not usually good for you and you often feel badly and it doesn't provide the benefits that you would normally think something like that would provide. That's not to say that the 12-hour rule will go. That is something that everybody should do.

The 12-hour time-restricted eating, that generally is regarded safe for most people. It's called breakfast.

Don't eat after dinner and eat breakfast. Okay, it's not a big stress. But for a lot of women who are sort of thinking about getting pregnant or breastfeeding or in this childbearing years, you have to be very cautious about what you're doing to your body and whether you're actually doing the right things you need to preserve fertility. Because when you're starving, which is kind of what you're doing when you're in these states, you're starving. The body doesn't want to have babies. It's dangerous, like it's dangerous to have a baby when there's no food around. So the body naturally will shift the hormonal function to stop menstruation, to stop ovulation, to lower testosterone, to do all these things for both men and women, which is okay from an evolutionary point of view, but long term is probably not a good thing.

And sometimes women will even lose their Periods. If they are extreme fasting or on an extreme juice cleanse.

Yeah.

All right, Mark, now is the part of the masterclass where we go to our community questions from Instagram, the podcast, YouTube, and email that we've selected here to go through. So here's the first question that we have from an individual asking, Does fasting affect high blood pressure?

Yes. When you do any of these, strategies that we talked about. Again, they all activate healing systems. So what causes high blood pressure? It's actually an inflammatory disease. It is a disease of oxidative stress. It's driven primarily by two main pathways. We call it essential hypertension, which means essentially we have no clue what causes it, but we actually do. And the two major drivers, there's others, right? Low magnesium, heavy metals, and so forth. the hormonal dysfunction, there are two major drivers. One is insulin resistance or the spectrum of poor metabolic health from pre-diabetes to type 2 diabetes, and that is extremely responsive to any of these strategies. And two, sleep apnea, which can drive all kinds of problems in the body, including insulin resistance and lead to high blood pressure. So you kind of got to look at those two things. And for intermittent fasting, time-restricted eating, keto diets, fasting mimicking diets, they will all help blood pressure.

All right, fantastic. Next question, how can you get enough calories if you lead an active lifestyle and still want to get the benefits of fasting?

It's a good point. I mean, I often will struggle because I will start to drop weight if I'm not careful. It's great for the 88% of people in America who metabolically unhealthy and who are overweight or skinny fat. So basically, nine out of 10 people, awesome. For weirdos like me, it can be tricky. So you have to make sure you in the time that you're eating, in the eight or 10 or 12 hours that you're eating, that you're getting enough food and getting the right food. So you often have to amp up some of the food you're eating, and it's okay to do that.

As a follow-up question to that, we have another individual asking, I fast all day easily, but once I have dinner, the craving to eat more is horrendous. Why is and is there anything that I can do about that?

Yes, yes. So here's the problem. Sugar and starch will jack up your insulin. Insulin makes you hungry and crave more carbs and food. When you load all your calories into a too narrow window, let's say I just eat one meal a day and you have to get 2,000 or 2,500 calories in one meal, it doesn't matter if it's the best food on the planet, any large meal will trigger an insulin spike. So you have to be, I mean, unless it's just pure fat, like unless you just drink olive oil, then it won't do that, but I don't think most people are doing that. So if you're having protein, that gets turned to sugar, it spikes insulin. You basically will start to jack up insulin, and that insulin is the hormone that makes you crave more food, makes you hungry and want to eat more, even if you just ate a huge meal. So you want to make sure you're not packing all your calories in one meal, that's a problem.

And it's not just how much you eat, it's also what you're eating during that window that you are eating. Can you just make that distinction?

Sure. Yeah, okay. So here's some interesting data. In time-restricted eating, it works even if you don't change your diet, like what you're eating, right? If you're still eating crap and you do that, it helps fix your metabolism. But it works way better if you eat the Pegan diet, meaning a whole foods, plant-rich, phytochemical-rich, high fiber, high quality fat, good protein, diet, which is what I recommend. So actually optimizing your diet will help optimize all these technologies as you're doing them.

Next question we have, should the fasting period get longer as you age over 50?

Should you fast longer when you age over 50?

Or should you fast at all after the age of 50?

Well, for sure you should and you can and it's helpful because what happens as we age is we need more cleanup, we need more repair, we build more waste, we have more old cells, we need more autophagy, more mitophagy, we need to build more muscle, we need to lose more body fat, we need to reduce more inflammation, because as we age, all these things start to go wrong that are really the result of not having the right strategy for optimizing our health. So the normal course of life in America is the typical American diet is lack of exercise, chronic stress, and unmitigated or unaddressed, those things will all accelerate aging. So any of these strategies will help to reverse that and actually reverse your biological age.

So we talked about this before, big picture, but I think it's worth hitting on again. So the question from the listener is, is it appropriate to continue intermittent fasting during pregnancy?

Yes, no, it's not. I mean, I would not recommend pregnant women do what you're saying is intermittent fasting, which is go for 24 hours or 36 hours without eating. Anybody can go 12 hours and I think we should and it's probably good for the baby to do that. Longer periods, 14, 16, you have to see how you feel. But I think one of the challenges I see with pregnancy is that doctors give women a free license to eat whatever they want. Just make sure you gain weight, make sure your baby is growing, eat ice cream and all this crap. bad idea. You have to still regulate your diet even more when you're pregnant because you're feeding the baby all the basic ingredients to grow and develop. So if you're not having a high quality diet, your baby is not being made of high quality ingredients. So you want to make sure that you optimize the quality of your diet while you're pregnant and not just eat ice cream and crap and that you actually are getting enough calories, which you need more calories, right? feeding too, but it doesn't mean you have to crap. And you can do a 12-hour overnight fast, which is fine. It's called breakfast.

But in general, it's really important to focus mostly on this, the quality component of it. And if you're doing that and you have certain cravings or other things like that, as long as you're eating mostly quality food, you really don't have to worry about timing and fasting. There's plenty of time to do that later on. No, no, no. Another question about women's health. Is intermittent fasting good for balancing hormones.

It's tricky because if you do too much fasting or too much starvation, you're activating systems in your body that are designed to prevent fertility. So you can go overboard. But most infertility in women is caused by too much sugar and starch. Insulin resistance. Insulin resistance. PCOS being one of the big culprits of it.

Polycystic ovarian syndrome.

But it's not an ovarian problem. It's a nutritional problem. and there's a book actually by a bunch of Harvard scientists called the Fertility Diet, which is about using an approach that lowers blood sugar to actually help fertility. So if you are one of those women who's insulin resistant, who's overweight, who's got belly fat somewhere on the spectrum of pre-diabetes, and by the way, 90% of people who have pre-diabetes have no clue. Like I said, 9 out of almost 9 out of 10 Americans have pre-diabetes. That's crazy, right? We said it was one out of two, had pre-diabetes or diabetes, but this new data from government surveys and lab testing has found that 88% of Americans have either high blood pressure, high blood sugar, or abnormal cholesterol. All of those are symptoms of insulin resistance, right? That's what's causing that for the most part. So when you look at that, you go, well, if you're in that state and your hormones are screwed up and women's hormones do get screwed up, they get lack of ovulation often, they'll get high levels of estrogen because all the fat tissue makes estrogen. They'll get increases in testosterone because of some of the ways the shunting of estrogen goes to testosterone. There's a whole chicken wire pathways that connects all the hormones of progesterone, estrogen, testosterone, very, very similar hormones. They're just slightly tweaked. You'll get more testosterone, which means you can get hair loss on your head, you can grow facial hair, you get acne, get irregular periods. So, intermittent fasting, time restricted eating, all these techniques all will help fix that because it fixes insulin resistance. For men, you know, it's interesting because men also have the same phenomena happen, but a little different thing happens. When they gain belly fat and they're having too much starch and sugar, it increases insulin, which then increases fat cells, which then produce estrogen, and lowers testosterone. So a lot of guys who have this will have low testosterone, low sex drive, low sex function, they'll have high levels of estrogen, they'll get loss of hair on their bodies, they'll grow man boobs, they'll kind of get smooth skin, so they look more like women. You've seen these guys, we have the beer bellies, and this is because they're eating so much dark sugar, so it can screw up men's hormones too. And on all these techniques will also fix that.

Do you have any mindset tips to help you through the process of fasting, whether it's time restricted eating or intermittent fasting?

I mean, you just kind of have to decide to do it. It's like, it's not actually that hard. I think, you know, anybody can do 12 hours and then you can try, you know, like, if I said, can you walk for one minute, unless you're really you know, old or decrepit or in a wheelchair, most people can walk for a minute, right? Then you walk for two minutes, then you walk for three minutes, and then you walk for four minutes, and then you walk for an hour, right? So it's basically starting to actually push the limits of what your body is comfortable with and starting to notice the effects and the benefits of paying attention. Like I said, your body is the best doctor in the room. It will tell you exactly what works and what doesn't.

Pay attention. Can you have coffee or tea when you're doing time-restricted eating or intermittent fasting?

That's a great question. I have understood that the answer is yes if it's got nothing in it, if there's no milk or sugar or cream or anything else, that it won't break ketosis or it won't cause that. Other people have said it might, but I think my gut feeling is that it probably won't have a huge impact because it's not a lot of calories and essentially it's just caffeine and water, basically.

Are there any other nutrients that you might tell people to include? And the answer could be no when they're in their fasting window. Is there any other things that we're looking for or is it more just letting the body do its thing?

I mean, I think most people, like I said, have always said should be in a multivitamin, fish oil and vitamin D. That usually covers most of the bases to keep all your metabolic pathways going because you are need more nutrients as you're fasting to actually clean up the waste, to regulate pathways and all the enzymes, all the functions in your body require nutrients. So I think it's important to people be on something. With that said, I don't think there's a reason to stop. I don't think there's a reason to take extra stuff unless you have a specific goal, like if you're trying to fix your liver or if you're trying to fix your kidneys or you're, you're working on something specific. But I think for most people, it's okay to just take a good multi-fish on vitamin D. and that they probably, not only it's okay, it's probably important to do that while you're doing some.

Type of time-restricted or intermittent fasting. What are the biggest mistakes people make.

When it comes to intermittent fasting? The biggest one is when we just talked about, people say, well, 12 hours is good, 14 hours is better. If 14 hours is good, 16 hours is better. If 16 hours is good, 20 hours is better. If that's good, 22 hours is better. And it's not, it's not. If you're doing time-restricted eating on a daily basis, you want to spread your calories out over that window of eight hours because you don't want to load up your system with too many calories in one meal. That is what will cause more problems. So I really don't encourage that. With that said, you know, people can do other forms of fasting like intermittent fasting where they really are having a full fast for 24, 36 hours. That's okay. But you don't want to constantly load all of your calories into too short a window. That's one of the biggest risks I see.

When it comes to intermittent fasting in the West, meaning North America, a lot of the UK and other places that follow very similar lifestyles, it's often that people will skip breakfast as a way to get into their intermittent fasting. I saw an episode that you did with Valter Longo where he said in most of the world when they practice fasting, especially in the East, they actually do have breakfast and they'll skip other meals in the day because breakfast helps power their brain and give them energy for the day. Do you have any thoughts on that? that?

Yeah, I mean, I think it depends on you. Sometimes people feel like I feel better if I just don't eat in the morning and I have more clarity and focus, but it also depends on what you eat. When I have my power protein, adaptogenic, microbiome, mitochondrial, immune boosting shake in the morning, I feel awesome, right? If I do it after my workout. But I usually give it at least 14 hours from dinner. So, I'll maybe do it at nine o'clock or something like that after a workout. Other people, if they have the wrong breakfast, it can really cause huge problems. If you're eating starch and sugar for breakfast, basically dessert for breakfast, which is breakfast in America, folks, right? Cereal, which is 75% sugar, and I like to say I'm a cereal killer. I don't think we should be eating cereal. It's one of the biggest myths and propaganda stories of our time. I think we should not be eating the typical American breakfast, which is pancakes, French toast, muffins, bagels, latte, frappuccino, mocha, hot chocolate, those probably have 600 calories of sugar in them. You know, those are not what we should be having for breakfast. We need fat and protein for breakfast. So if you start your day with fat and protein for breakfast and phytonutrients, you're gonna do way better and your brain will be fine. But it's also okay if you wanna skip dinner and have breakfast and eat lunch and not eat late in the day. That's okay too. I think that's a fine way to do this.

There's no trick. You can try both ways and see how you feel. Mark, what else do you wanna talk.

About when it comes to fasting? There's some interesting components that we didn't get a chance to touch on. So, I'm going to get a little geeky here, guys, because this is the stuff that interests me and hopefully it'll interest you, which is that there are master control switches for aging and health. And, they're often genes that regulate our metabolism and our mitochondria. So, when I say metabolism, what does that mean? It means how well does your body burn food. In other words, when you take oxygen and calories that you eat in food and you burn them, they burn in a little part of your cell called the mitochondria. And there's tens of thousands of these in the cells you have. And this system has to work well in order for you to be healthy. Many of the things we do cause our mitochondria to age fast and cause them to slow our metabolism down and to have poor function. And that leads to loss of energy, that leads to all the disease. I mean, everything we see is a mitochondrial disease. Heart disease is a mitochondrial disease, diabetes is a mitochondrial disease, Alzheimer's is a mitochondrial disease, Parkinson's is a mitochondrial disease. I mean, all these things are mitochondrial. So, what are the switches that we can play with that we can use the science of when we eat and what we eat to actually activate these pathways that are embedded in us again that are way, way smarter than any pharmaceutical company than any human being. We've been designed to have these systems that literally will reverse aging. So as we begin to study these strategies, including calorie restricted eating, they do a number of things. There's a number of genes in the mitochondria that regulate our insulin and blood sugar and metabolism. DAF-2, FOXO, mTOR, and these are really important genes and sirtuins that regulate all these downstream effects. You want to change the expression of those genes so you can optimize the function of your mitochondria, which is the key to longevity. It's the key to healthy life. It's the key to having energy. So you don't really have to know about all this sciencey, geeky stuff, but these particular pathways around Sirtuins and FoxO and DAF-2 and mTOR, they're all regulated by our diet and by the quality of our diet and by the timing of eating and by all these techniques we just talked about. And I remember talking to one of the scientists, I was in a longevity conference that was in Upstate New York. I was at Menla, which is Robert Thurman's retreat center, that's a Tibetan retreat center and he had the Dalai Lama there. all these Tibetan doctors and every Nobel Prize winner and aging and longevity and health. It was quite a collection of people. And the talks were fascinating. And this one guy from MIT, Leonard Guarente, is the scientist that uncovered this pathway around sirtuins. Now, we've all heard, oh, red wine is good for you and resveratrol is great and it can extend your life. Well, he's the guy who kind of figured a lot of that out with David Sinclair. And, I said to him, what's the deal with these HRTUINS? What is the thing that's causing them to be dysfunctional, to cause a decrease in mortality, increase in disease, and how do we fix this? He looks at me and he goes, well, it's pretty simple. It's sugar that messes it all up. So it's literally sugar and starch that are causing all these genes to be dysregulated. So what's the antidote to sugar and starch in our diet? It's intermittent fasting, time-restricted eating, keto diet, fasting, mimicking diet, all these strategies are designed to reverse the harm that sugar has done to our cells. So you don't actually have to understand all this kind of fancy terms, but you just need to know that your body has these master switches that regulate aging, longevity and health. And the key to living long and healthy is learning how to activate those switches. So that's the beauty of all these techniques. You just do what they say and it'll do it automatically.

That'S beautiful. And sugar can be so addictive. And you've built an entire program around helping people called the 10-day sugar. You built your whole life around sugar. You know, a great documentary called Fed Up, but the 10-day detox diet. There's a book. It's out there.

People can get it. They can follow that plan. Yes. I mean, I, you know, I think, I think I wrote this book. It was probably 2014, so I wrote it in 2012. You know, I always, I always see things in my practice with patients, and I, and then I'm like, this is coming. something about this is coming. And I can understand that with sugar, the science around addiction, not just, oh, I want it or I need it or I like it, but actually biological addiction, where you have clear pathways that are activated in the brain that are the same that are activated with heroin or cocaine, where there's clear withdrawal symptoms from not eating it. It really meets the criteria of of sugar addiction. I'm going to tell you one quick story about it and why I wrote the book and how people can learn how to get unhooked, right? Because it's really important. You're listening to this, you're going, oh my God, Dr. Hyman, you're right, but I love sugar. I don't know, I try to stop, I can't, I just crave it. It's overwhelming, I just don't know what to do. I got you, I got you. It's not that hard. So what happens is when you are looking at at the science about this. It's fascinating. I mean, they've taken a mice, for example, and these are kind of cruel and mean, but, you know, scientists do this. They literally would give them cocaine and they hook them up to an IV of cocaine. And if they hit this button, they would get as much cocaine as they wanted. Or, they could go eat some sugar. They would work eight. They would literally give up the cocaine and go get the sugar. And they would work eight times harder to get the sugar than to get the cocaine. That's frightening. Another study, they put them in this special cage with an electric floor, and whenever they ate sugar, they would shock them. Now, most time when you shock an animal, it will avoid whatever the thing is that shocked them. These mice would keep eating the sugar even while they're getting shocked. Now, that's a pretty cruel study, but it's It's pretty impressive when you look at the results. There was a human study where they didn't put them in a cage, they didn't shock them or anything like that, but they took overweight guys and this was done by Harvard scientists, rigorous study published in major journal, like I think Journal of the American Medical Association. It's not like a kind of a third rate study. This is a powerfully well done and well designed study by David Ludwig. And they took overweight guys and they gave them on different days, different milkshakes. Now the milkshakes were identical in calories, in protein, in fat, in carbohydrate and fiber. So macronutrients were identical. The only difference was one of the milkshakes had a slowly absorbed sugar to not spike your blood sugar and the other one had a rapidly absorbed starch or sugar. But they tasted the same. You couldn't tell them apart. so they took these guys and one day they gave the low starch one and then the high sugar one. And then they measured their blood, they put them in MRI scanners, they looked at functional MRIs of their brain. The group that had the low starch sugar were fine. They didn't activate any Pathways related to addiction, their blood sugar and he stayed even, their lipids were fine, their cortisol was fine. The group that had the high sugar one actually, not only did they activate adrenaline, which is a stress hormone, cortisol was a stress hormone, insulin went up, blood sugar went up, blood pressure went up, cholesterol went up. But when they did the brain imaging, they found the area in the brain that's responsible for addiction, biological addiction, like heroin, cocaine, that kind of stuff, called the nucleus accumbens. It lit up like a Christmas tree. So you're like, whoa, they don't even know that they're eating something different. It's like, oh, I have so much pleasure. it feels so good, this milkshake tastes so good, this one tastes terrible. They tasted the same. So it wasn't even a felt emotional response. It was literally the biology of sugar, which is staggering. So, and there are many, many studies. So I wrote this book, the 10-Day Detox Diet, because so many people are addicted to carbohydrates and sugar. When I say sugar, I mean starch and sugar because white flour, which is the main starch in this country, is got a higher glycemic index than table sugar, meaning a sandwich will raise your blood sugar more than two tablespoons of table sugar. That's not good. We have to think about them the same. But that's why I wrote the 10 Day Detox Diet, which is to design a way of eating and a few simple lifestyle hacks that changes your hormones like that within a day or two. I remember teaching a workshop at Kripalu once years ago and this woman came in and was to do the 10 Day Detox Diet. and she was like, Dr. Hyman, I really know I gotta get off sugar. I just can't. I've been eating my whole life. I try, I try, it never works. I doubt this is gonna work. I'll try it, I'll do it, but I don't think you're gonna be able to help me. And I'm like, okay, let's see what happens. So we had the whole program developed. We had broths, we had shakes, we had all the food designed exactly, and it's all designed in a scientific way to balance all your brain chemistry, to balance your hormones, to balance insulin. to fix everything. And after day two, she's like, I don't happen, Dr. Hyman. My cravings are gone. I don't really want anymore. Like, I'm done. Like, I'm like, wow. And so when you, when you understand how hard it is to quit, but how if you use science, not willpower, you can literally hack food and sugar addiction. And that's really what the 10-day detox diet is about.

A powerful testimony. And luckily, there's a lot of new apps and tools and gadgets that are coming on the market. There's one that you're involved in. It's called levels. Yes. It's continuous glucose monitor. Just chat a little bit about that. It's not for everybody, but it could.

Work really great for a lot of folks. Listen, everybody is different. In terms of your response to foods, you can't say you're like your friend or your sibling or your parent. You don't know. We just don't know how our own biology responds. And I'll just start with a little anecdote about a research study that was done in Israel a number of years ago. And in this study, they looked at how different people responded to the same foods. Think, okay, if I eat a slice of bread, it should raise my blood sugar the same as yours or as yours or whoever is listening. But it doesn't work like that. So what they found was, and this was a very kind of nuanced study, but they did was they found that looking at the microbiome, which is the mass of bacteria in your gut, they were able to predict different responses based on the microbiome. So not everybody's blood sugar went up the same with the same food. It depended on what was going on in their gut. That's just sort of one example, right? So not everybody has the same response to any particular food, which is why it's so important to know your body. And I'm so excited about these new technologies called continuous glucose monitors or CGMs. and this company, Levels, has really nailed it. And they had an advisor, an investor, just to be transparent, but they really nailed it. And they figured out how to have this little tiny device that goes on your skin, a little patch, and it measures your blood sugar all the time. And you can tell, I remember during the first time I used it, I put it on, I was visiting a friend of mine in Martha's Vineyard, and there was this sort of regenerative, organic farm, and they cooked all these gourmet foods. and they brought this feast of lamb and veggies and this and that, and it was all healthy. It was all really yummy food. And my friend, who was actually also my age, but he's super fit, he's muscular, thin, healthy, seriously healthy, and we both put it on, we both had this meal, and then we were in bed at 10 o'clock at night checking our blood sugar, and we're texting each other, what's going on? Our blood sugar is like 160. How does this happen? both of us freaking out. I'm like, I think it's just because we ate too much food. So even if you just eat too much food, even as healthy, we'll do that. So you don't really know. And I, you know, I remember I was using it when I was in Hawaii, and someone brought over this vegan macadamia nut ice cream, which was so freaking good. And I ate a little too much, and I was like, whoa, it just spiked my blood sugar. Whereas, you know, maybe another food wouldn't do that. So it's really good to know. what your body's doing, which is why I recommend people to, in order to understand what's happening to measure blood sugar. But I've talked to Casey who's the founder of the company. I said, look, blood sugar is great. We need to know it. But more important is insulin because a lot of people have blood sugar very well controlled until the last minute. Because having high blood sugar is kind of dangerous. So the body has really good mechanisms for keeping it in control until it doesn't. which is then called diabetes. So the mechanisms can go on for 20, 30 years where your blood sugar stays normal but your blood insulin keeps going up and up and up and up. And the insulin itself will cause havoc even if you don't have diabetes. It causes heart attacks, strokes, cancer. It can cause belly fat gain, muscle loss, inflammation, on and on and on. So fatty liver. So just because your blood sugar is okay doesn't mean you're okay. But it's a first step and I think we're gonna be measuring insulin soon when they figure out the technology around.

That, but I can't wait for that to happen. It's all coming. It's all coming in the future. And in the meantime, there's plenty that you can do even without gadgets and devices to head in the right direction. Mark, let's do a little bit of a recap on this conversation on fasting and tell us like if people are just going to get started after listening to this conversation, what is literally step one and take us through a little bit of a recap of some of.

The things that we covered. I mean, look, the easiest thing to do for everybody is just a 12 hour fast, which we talked about. If you want to extend it to 14, 16, play with that, that's the easiest approach to activating these systems. Fasting for 24, 36 hours once a week, another option, a little more tricky, harder to do, not going to kill you, but we do it on Yom Kippur or people doing Ramadan or stuff. It's in cultures, but it's a little harder. Keto is even harder. And calorie restriction, you can't do that long, you can do it for five days, so people can do that. so there's all these different choices people have. And even the five-day fasting, mimicking diet can be really effective. You can do it on your own, which is 800 calories a day, or you can use various products from Valtor Longo. It all goes to his research, which is quite good, called Prolon. That's an option. But for most people, just doing the 12 to 14, 16 hour fast is great. So why should you bother? Well, we all need to go to the repair shop, right? We can't just live. I mean, you forget about your car and not take it into the shop for repairs, not take it in for an oil change, for tune up. You know, we go in and have like the thousand point checkup. We reset everything and it runs beautifully. We can do that for our bodies. And that's what these techniques do. So just to recap, they activate every system in your body that's designed to protect you, heal you, and make you live longer. It reduces inflammation, which is the biggest cause of aging. It increases your antioxidant systems, which are important. it causes you to lose belly fat, it increases muscle, increases bone density, increases your brain function, reduces insulin, blood sugar, cholesterol, helps with diabetes, can help prevent or even reverse cancer in some cases. So there's so many benefits to it and it activates these mechanisms called these longevity mechanisms around sirtuins and DAF-2 and FOXO and mTOR. So there's a whole strategy around how to use these technologies to actually increase your well-being, to lose weight, to reverse chronic disease, and to live longer.

I feel inspired to fast. I feel inspired to not eat anything.

I'm going to dinner.

Mark, thank you for this. I'm going to pass it back to you to conclude us out here for today's masterclass.

Well, thanks Drew. I think I gave a good recap. If you love this masterclass, which I hope you did, because I had fun, and Drew, I think you had fun, then I would encourage you to share it with your friends and family because people need to know this information. Subscribe where you get your podcast. If you've tried any of these techniques, share your experience with us. We'd love to hear in comments about this and learn from you. And of course, we're going to see you next week on the Doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. and I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter, and in it I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to Dr. Hyman.com/picks to sign up. That's Dr. Hyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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